Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip and questions answered for families in intensive care.
He’s 77 years of age and he’s got low blood pressure, and this is affecting his heart. We call the hospital daily as we are two to three hours drive from the hospital, but we ask if he’s improved, they just say he’s stable. The ICU tried to wake him today but sedated him again as he was agitated and in a panic. We are unsure what it all means and we would like to know that he’s getting better.
We understand this is going to take time, but we don’t know exactly what and why they’re keeping him sedated and feel they’re not telling us everything and we’re also unsure what to ask as we’re frightened and don’t want to be negative. We are just unsure of the correct questions we should be asking as we are not medically trained in any way and find it all very confusing. Thank you for your time to respond to my query. From Mary.
Hi Mary. Thank you for sending in your question. So, there’s a number of things to look at in your situation. Your dad is in ICU with a severe pneumonia and he’s now on a ventilator and in an induced coma. So, the question really is, why did he end up on the ventilator in the first place where they’re not able to treat the pneumonia, you know, without getting one of the ventilator.
Did he have BiPAP for example? Did he have high flow oxygen therapy? Did they start antibiotics early enough? So those are all questions that you may want to ask why he went on the ventilator in the first place. Why could he not maintain a safe airway? And as I always say, the biggest challenge for families in intensive care is simply that you don’t know what you don’t know and you don’t know what to look for. You don’t know what questions you need to ask, and that seems to be exactly your situation.
So let’s dive into your questions a little bit more in detail. So you’re saying he’s got low blood pressure and that is affecting his heart? Yes, he’s got the pneumonia and he’s probably hypotensive because of that, because of the infection which often means in ICU, the combination of an infection, low blood pressure, as well as sedation causes low blood pressure to the point where that needs to be supported because otherwise it may not be sustainable with life or compatible with life. And therefore inotropes or vasopressors are started to maintain a physiological blood pressure.
Inotropes or vasopressors that often used in the ICU are noradrenaline, norepinepherine, adrenaline or epinephrine, and for a weak heart, sometimes also dobutamine or milrinone. So if he’s got a weak heart and they may have done an ultrasound of his heart by now to find out if he’s ejection fraction is low, for example, or whether he’s had, God forbid, the heart attack. You know those are all important things that you need to look for.
You’re saying that when you call the hospital and you ask them if he’s improved they just say he’s stable. That’s what most hospitals say but it’s a question of asking the right questions. And that’s why I’m helping you now so you can ask the right questions.
I told you about inotropes or vasopressors, you can ask for that, for example, then you’re saying the ICU tried to wean him up, but they sedated him again because he was agitated and in a panic. Again, Mary, that’s not unusual that when you try to wake up patients from an induced coma that they don’t come out at first, it might take a few attempts.
If, God forbid, he can’t come off the ventilator, and he can’t come out of the induced coma. He might end up with a tracheostomy, but it’s too early to talk about a tracheostomy. But I’m just trying to tell you about options down the line, if you know, if he can’t come off the ventilator. And you’re right they’re not telling you everything. But again, it also comes down to asking the right questions. And again, that’s what I’m trying to help you with.
So the other thing you need to find out is what ventilation settings is your dad on? Can he be weaned off the ventilator? What are his arterial blood gases like? What does his chest x-ray look like? What antibiotics is he on for the pneumonia?
You know, and asking them, is he making progress towards having the breathing tube removed? Is he making progress towards having his pneumonia cured. Other things to look for are, ask for blood results such as white cell count. If the white cell count is high, it’s still a sign that the infection is ongoing, that they haven’t cured the pneumonia yet. Ask for things like renal function or kidney function. Again, if he’s got the low blood pressure, his kidneys might be impaired just by not having enough blood flow to the kidneys with a low blood pressure.
So those are some of the questions you need to ask. But most importantly, yes, your right, he needs to come out of the induced coma so they can wean him off the ventilator. But the next thing they need to do is treat the pneumonia with IV antibiotics, intravenous antibiotics and then your dad can be woken up and hopefully then he can come off the ventilator.
I hope that helps Mary. That’s hopefully your question answered for today. If you have any other questions, send me an email to [email protected] or call me on one of the numbers on the top of the website.
Thank you for watching. This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.